The Well-Being Journal

New Study Demonstrates Impact of Care Transitions in Preventing Hospital Readmissions

Cameron Bowman

To circumvent the $17 billion in preventable readmissions costs paid by Medicare each year, financial incentives imposed by the Hospital Readmissions Reduction Program (HRRP) now penalize hospital and healthcare providers for unnecessary or excessive readmissions for several common diagnoses. These conditions include heart failure, pneumonia, heart attack, COPD, elective hip or knee replacement procedures and, beginning in October 2016, coronary artery bypass grafting.

In the past year, over 2,500 hospitals nationwide received penalties amounting to $420 million because they did not meet HRRP requirements, and of those, 38 hospitals accrued the maximum possible penalty. In order to avoid punitive measures, healthcare providers are increasingly concerned with improving overall quality of care and reducing the rate of preventable hospital readmissions. A recent study published in the American Journal of Managed Care highlights the effectiveness of one solution aimed at lowering preventable readmissions through a comprehensive, patient-centric approach.

The Healthways Care Transitions Solution® demonstrated impressive results in real world analysis, reducing 30-day readmission risk by 25% overall and the odds of any readmission within six months by over half among program participants with readmission penalty conditions, including heart failure, heart attack, chronic obstructive pulmonary disease and/or pneumonia. By addressing the underlying causes of preventable readmissions, rather than just managing the primary diagnosis, the program improved the overall health of patients and allowed hospitals to efficiently implement an effective approach to reduce the number of preventable hospital readmissions.

Through the use of science-based predictive modeling, the program is able to selectively deliver care to those patients at the highest risk of readmission prior to discharge. Additionally, trained clinicians complete follow-up interventions with patients telephonically to prevent readmissions post-discharge. The Healthways Care Transitions Solution represents the type of innovation that is increasingly in demand by health systems, physicians and patients.

Earning the exclusive endorsement of the American Hospital Association, the acute and post-acute care transitions management solutions provided by Healthways succeed not only in effectively navigating the shift from fee-for-service to value-based care, but also supports the interdisciplinary management of patients across the continuum of care.

For more information on the Healthways Care Transitions Solution, view our webinar or download our fact sheet.

To read the full study, click here.

Topics: Healthcare Trends in Healthcare Science and Research Care Transitions Solution

World Faces Shortage in Purpose Well-Being

Madison Agee

Latin Americans have highest well-being in this area
By: Melanie Standish and Dan Witters

Fewer than one in five adults worldwide can be considered thriving -- or strong and consistent -- in levels of purpose well-being, as measured by the inaugural Gallup-Healthways Global Well-Being Index in 2013. Residents living in the Americas are the most likely to be thriving in this element (37%), while those in Asia and the Middle East and North Africa are the least likely (13%).

Purpose Well-Being, by Region

The Global Well-Being Index measures each of the five elements of well-being -- purpose, social, financial, community, and physical - through Gallup's World Poll. Purpose well-being, which is defined as people liking what they do each day and being motivated to achieve their goals, was the lowest performing element of the five elements of well-being. Global results of how people fare in 135 countries and areas in this element, as well as the four other elements, have been compiled in the State of Global Well-Being report.

Latin Americans Have Highest Purpose Well-Being

Nearly all the countries with the highest thriving rates of purpose well-being in the world are in Latin America. Culture may play a role in these perceptions -- Latin Americans generally report higher levels of positive daily emotions and have a better outlook on the job market than any other regional group. Denmark was the sole non-Latin American country in the top 10 countries with the highest percentage of the population that is thriving in purpose well-being.

Purpose Well-Being, Highest Ranked Countries

Panama led the world in four of the five well-being elements -- including purpose well-being. Two in three Panamanian adults were thriving in purpose well-being. Panama's strong and growing economy with an unemployment rate of 4.5% in 2013, coupled with investments in national development could be contributing to these high levels of thriving in well-being. Neighboring Costa Rica followed at 50%, despite relatively high unemployment for the region -- nearly 9% in the third quarter of 2013.

Struggling Economies and Conflict Zones
Dominate Low Purpose Well-Being

Asia and the Middle East and North Africa performed worst in purpose well-being, with only 13% of adults in these regions thriving in this element. However, when looking at adults' perceptions at the country level, trends among countries emerge and the lowest percentages appear to be associated with conflict zones and countries with poor economic performance.

Afghanistan and Syria struggled most in this element and had the lowest levels of purpose well-being, with 3% or less of adults thriving in this element. These two countries along with Tunisia, and to a lesser extent, Armenia, are embroiled in armed conflicts, which have disrupted daily lives and prevented portions of the population from carrying out normal functions.

Purpose Well-Being, Lowest Ranked Countries

Poor economies may also have affected purpose well-being. With only 7% of the population thriving in purpose, Greece is grappling with an economy that has yet to recover from the European debt crisis. Croatia has also suffered negative GDP growth since 2009 and high unemployment rates compared with Western European countries.

High Purpose Well-Being Influenced by Demographics of
Education, Wealth, and Youth

Worldwide, demographics play a role in the likelihood that people are thriving in purpose well-being. Those who were in domestic partnerships or who had completed four years of education beyond high school were more likely to be thriving in purpose well-being (27%) than the global population as a whole (18%).

The wealthiest quintile, urban residents, the young, and office workers were also more likely to be thriving than their poorer, more rural, older, or non-office worker counterparts. Globally, however, there was no difference in the level of thriving between men and women. Eighteen percent of each were thriving in this element.

Purpose Well-Being and Global Demographics, Highest %

Certain Employment Sectors and Less-Educated
Have Low Purpose Well-Being

Globally, adults who were employed in the fishing, forestry, and agriculture sectors were the least likely group to be thriving in purpose well-being, with 11% of respondents providing responses that placed them in this category. Those with an elementary education or less followed at 13%.

Purpose Well-Being and Global Demographics, Lowest %

The only region where education levels did not significantly affect people's likelihood to thrive in purpose well-being was the Middle East and North Africa region, where 14% of those who have completed at least four years of education beyond high school are thriving in purpose, matching the 14% whose education did not go beyond the high school and tertiary level. In every other region surveyed, more highly educated respondents were significantly more likely to be thriving in purpose well-being than their less-educated counterparts in this element.

Women were significantly less likely to be thriving in purpose well-being (16%) than their male counterparts (20%) in former Soviet Union countries. The Americas saw women (36%) with slightly lower levels of purpose well-being thriving rates than their male counterparts (38%). There were no differences between genders in any of the remaining regions.

Implications

Purpose well-being is high when people like what they do each day and are motivated to achieve their goals. This is true whether they work for a company, are self-employed, care for family members, pursue education, work on a farm, or engage in charity work. Those with high well-being in this element also tend to be highly engaged in their work. They are emotionally invested in what they do and focus on creating value through their efforts.

When people are unable to find work or achieve other personal measures of success and well-being with respect to their purpose, it can impact areas beyond the individual and affect society as a whole. Such conditions fed the Arab Spring uprisings and fueled protests in European countries that enacted severe austerity cuts. In Panama, residents who have high purpose well-being (66% thriving) were more than twice as likely (at 37%) to have donated money to charity in the last year than were Mexicans (16%), whose purpose well-being level was only at a 33% thriving rate.

"It is important for any stakeholder who is interested in improving the health of their population including governments, community leaders, employers, insurers and other international organizations to understand the impact that purpose well-being has on overall well-being," says Peter Choueiri, President, Healthways International. "Our research shows that purpose well-being has a high correlation with social, financial, community, and physical well-being. In other words, investments in purpose well-being improvement will likely also lift the other elements of well-being resulting in lower medical costs and an improvement in productivity across whole populations."

Survey Methods

Results for the Gallup-Healthways Global Well-Being Index are based on telephone and face-to-face interviews on the Gallup World Poll, with a random sample of approximately 133,000 adults, aged 15 and older, living in 135 countries and areas in 2013.

For results based on the total sample of national adults, the margin of sampling error is less than ±1 percentage point at the 95% confidence level. For results based on country-level samples, the margin of error ranges from a low of ±2.1 to a high of ±5.3.

All country-level analyses use country weights. Global and regional analysis uses projection weights that account for country size. Minimum sample sizes of N=300 apply.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

Each element in the Global Well-Being Index contains two questions asked of all respondents:

Purpose

  • You like what you do every day.
  • You learn or do something interesting every day.

Social

  • Someone in your life always encourages you to be healthy.
  • Your friends and family give you positive energy every day.

Financial

  • You have enough money to do everything you want to do.
  • In the last seven days, you have worried about money.

Community

  • The city or area where you live is a perfect place for you.
  • In the last 12 months, you have received recognition for helping to improve the city or area where you live.

Physical

  • In the last seven days, you have felt active and productive every day.
  • Your physical health is near-perfect.

This article is the second of three articles exploring worldwide perceptions of well-being in the five well-being elements measured in the Gallup-Healthways Global Well-Being Index: purpose, social, financial, community, and physical.

Topics: Well-Being In the News Healthcare Well-Being Index Gallup

Country Well-Being Varies Greatly Worldwide

Madison Agee

Panamanians have the highest well-being globally; Syrians and Afghans, the lowest
By: Melanie Standish and Dan Witters, Gallup

One in six adults worldwide are considered thriving -- or strong and consistent -- in at least three of the five elements of well-being, as measured by the inaugural Gallup-Healthways Global Well-Being Index in 2013. Residents of the Americas region are the most likely to be thriving in three or more elements (33%), while those in sub-Saharan Africa are the least likely (9%).

Elements of Well-Being - Worldwide and by RegionEach element of well-being is important on its own, but the elements are also interdependent and well-being is more than the sum of the elements. That only 17% of residents in the 135 countries and areas surveyed are thriving in three or more elements underscores how most of the world is struggling to achieve high well-being.

More adults globally are thriving in community well-being (26%) than in any other element. Residents in the Americas region, with more than one in three (37%) thriving, are most likely to be thriving in this element. Adults in sub-Saharan Africa are the least likely to be thriving (18%).

Fewer adults globally are thriving in purpose well-being than in any other element. Adults in Asia, as well as the Middle East and North Africa, are least likely to be thriving in this element (13% in each region), while those in the Americas again top the list of regions, at 37% thriving in purpose well-being.

Global Well-Being Index Largest Recent Global Study of Well-Being

The Global Well-Being Index is an extension of more than six years of research and 2 million interviews in the U.S. through the Gallup-Healthways Well-Being Index. The Global Well-Being Index is a global barometer of individuals' perceptions of their well-being and is the largest recent study of its kind. Data collected in 2013, across 135 countries and areas, and with more than 133,000 interviews, have been compiled into the State of Global Well-Being, a comprehensive report presenting the global demographics of well-being. The Global Well-Being Index is organized into the five elements:

  • Purpose: liking what you do each day and being motivated to achieve your goals
  • Social: having supportive relationships and love in your life
  • Financial: managing your economic life to reduce stress and increase security
  • Community: liking where you live, feeling safe, and having pride in your community
  • Physical: having good health and enough energy to get things done daily

In analyzing the results of the index, Gallup classifies responses as "thriving" (well-being that is strong and consistent), "struggling" (well-being that is moderate or inconsistent), or "suffering" (well-being that is low and inconsistent).

Thriving Rates Highest in Latin American and European Countries

Adults in Latin America are most likely to be thriving in well-being in three or more elements as well as across elements. Latin Americans generally report higher levels of well-being than any other regional group. This is consistent with other Gallup World Poll research that shows residents of Latin America generally evaluating their lives more highly than those in other regional groups, partly reflecting a cultural tendency in the region to focus on the positives in life.

Thriving in 3+ Elements of Well-Being - the 10 Highest CountriesPanama leads not only the region, but the world in four of the five well-being elements -- purpose, social, community, and physical well-being. Sixty-one percent of Panamanians are thriving in three or more elements, 17 percentage points ahead of its second-place neighbor, Costa Rica (44%). Panama's strong and growing economy, an unemployment rate of 4.5% in 2013, and national development may be the most significant factors contributing to its high thriving levels.

Financial well-being is the only element in which other countries' residents top Panama's. Swedes lead the world in financial well-being, with 72% thriving. Financial well-being is high across a range of northern and central European countries, including Austria (64% thriving), Denmark (59%), and the Netherlands (56%).

All Elements of Well-Being - 10 Highest CountriesOnly five countries outside of the Americas and Europe regions have levels of thriving within an element that rank in the top 10 of all countries -- Bahrain in financial well-being (48%), Saudi Arabia in community well-being (43%) and physical well-being (39%), Malta in social well-being (47%), and Sri Lanka (50%) and the United Arab Emirates (49%) in community well-being. No countries outside of these two regions finished in the top 10 in thriving in three or more elements.

Sub-Saharan Africa Least Thriving Region

Adults in sub-Saharan Africa are the least likely to be thriving in three or more elements of well-being (9%), in addition to their low levels of financial well-being (9%), social well-being (16%), community well-being (18%), and physical well-being (20%). Democratic Republic of the Congo (DRC), Chad, Madagascar, Uganda, and Benin residents have some of the lowest levels of thriving in the world. Most of these countries are plagued by war, political turmoil, low levels of development, and endemic corruption. DRC, for example, has been embroiled in nearly continuous conflict since 1996, and is rife with political instability.

Although subjective well-being is dire in many sub-Saharan African countries, the situation is worse in Afghanistan and Syria. In 2013, just 1% of Syrian and Afghan adults were thriving in three or more elements; the two nations share the lowest well-being of the 135 countries and areas in the 2013 survey. Both countries are conflict zones. By the end of 2013, the United Nations High Commissioner for Refugees estimated that 6.5 million of a total population of 22 million Syrians would need humanitarian aid, and 4.25 million of those would be internally displaced.

Thriving in 3+ Elements of Well-Being - the 10 Lowest CountriesAfghans are also awash in uncertainty about the country's future security situation and its relative stability once foreign aid and investments level off. In a 2013 Gallup World Poll survey, more Afghans said their standard of living was getting worse than in any year since 2008, and most Afghans (61%) said it was a bad time for them to find a job. Against this backdrop, Afghans are the most likely of any population in the world not to be thriving in any element of well-being (75%).

All Elements of Well-Being - 10 Lowest Countries
Implications

Objective measures including GDP, life expectancy, and employment statistics are important and useful in assessing a country's "success," as are historical trends over time. However, the concept of subjective well-being encompasses the broader aspects of a life well-lived.

Gallup and Healthways research has shown that people with higher well-being are healthier, more productive, and more resilient in the face of challenges such as unemployment. People with higher well-being bounce back faster, are better able to take care of their own basic needs, and feel better able to contribute to and support the success of their organizations, communities, or countries.

Subjective well-being does not necessarily correlate with GDP, the presence of conflict, or other absolute indicators. Residents in poor countries may report that they have high well-being in certain well-being elements while those in wealthy countries may report that they have low well-being in particular elements. War-torn populations such as those in Syria may have extremely low well-being, but low levels are also found in countries that are relatively stable, such as Croatia and Italy.

There are policy implications for country leadership, development organizations, employers, health insurers (private and governmental), and others in the well-being status of their constituents. For example, Mexico has relatively high physical well-being scores. However, the country overtook the U.S. in 2013 as the most obese country in the Western Hemisphere and grapples with a high rate of diabetes. Diabetes and heart disease are the two most common causes of death in Mexico. While the physical well-being element captures more than just obesity, the high scores on this element in Mexico reveal areas where education is needed to help the population become more aware of health and healthy behaviors, and make better choices.

Because subjective well-being can correlate with outcomes such as healthcare costs, productivity, and business performance, world leaders should consider well-being, in addition to objective measures such as GDP, to provide a better picture of progress toward specific policy and development goals.

Survey Methods

Results for the Gallup-Healthways Global Well-Being Index are based on telephone and face-to-face interviews on the Gallup World Poll, with a random sample of approximately 133,000 adults, aged 15 and older, living in 135 countries and areas in 2013.

For results based on the total sample of national adults, the margin of sampling error is less than ±1 percentage point at the 95% confidence level. For results based on country-level samples, the margin of error ranges from a low of ±2.1 to a high of ±5.3.

All country-level analyses use country weights. Global and regional analysis uses projection weights that account for country size. Minimum sample sizes of N=300 apply.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

Each element in the Global Well-Being Index contains two questions asked of all respondents:

Purpose

  • You like what you do every day.
  • You learn or do something interesting every day.

Social

  • Someone in your life always encourages you to be healthy.
  • Your friends and family give you positive energy every day.

Financial

  • You have enough money to do everything you want to do.
  • In the last seven days, you have worried about money.

Community

  • The city or area where you live is a perfect place for you.
  • In the last 12 months, you have received recognition for helping to improve the city or area where you live.

Physical

  • In the last seven days, you have felt active and productive every day.
  • Your physical health is near-perfect.

This article is the first in a series of three articles exploring worldwide perceptions of well-being in the five well-being elements of the Gallup-Healthways Global Well-Being Index: purpose, social, financial, community, and physical.


Download the Global Well-Being Index Report

Topics: Well-Being In the News Healthcare Well-Being Index Gallup Science and Research

The Central Tendon

JohnAnderson

By: John Anderson, MD, FACS, Senior Vice President, Navvis Healthways

As a young surgeon some years ago, I had wonderful teachers and mentors who imparted to me a number of fundamental principles of practicing medicine. Though initially intended to be applied in clinical settings, a number of these principles I learned early on have sensible application to the complex domain of healthcare more broadly defined than traditional medicine and surgery. I’ve discovered this as I’ve increasingly devoted my career in recent years to the administrative side of medicine and healthcare.

For example, one mentor used to say that every patient – and more specifically, every surgical patient and every operation – had a “central tendon” which, when identified and “clipped,” made everything else seem minor and secondary. I quickly learned that this principle was significantly true in a clinical setting and have since realized it has much broader relevance.

As the Patient Protection and Affordable Care Act, aka ObamaCare, has swung into full gear with the opening of the exchanges and the expansion of Medicaid in 2014, virtually everyone believes that the healthcare industry has crossed into a very different place. This new reality has already begun to challenge our market’s brightest and most innovative minds to generate solutions that will position the American healthcare system as one to be emulated, rather than one that lags behind in virtually every imaginable dashboard metric. We as a country can do better…much better.

That said, here are a few observations regarding the current situation that I believe to be essential, beginning with my own view of what the “central tendon” might actually be. This short list is by no means intended to be comprehensive, rather just one person’s view of a few things that should be top of mind when thinking about how we fundamentally change and innovate our way out of the current reality with all of its issues.

Issue 1 – Physician Engagement

Others might have a different view, but I believe that “physician alignment” or perhaps preferably, “physician engagement” is just that central tendon issue, from which most all else in healthcare flows. Still the most respected and admired profession in the world, doctors always have and always will have a distinctive and irreplaceable role in the so-called conscience of the healthcare debate. (That in no way is meant to disrespect or undervalue the role of so many other healthcare professionals, especially that of nurses who will forever be the most intimate of partners with physicians at the sharp end of care. Enough said on that lest I be misunderstood.)

While not everyone will agree with me, I for one believe that our historically bifurcated payment schemes have ­– more than anything else over the last 75 years – driven doctors and hospitals further apart. Doctors ran the doctor business, and hospital administrators did likewise for facilities. Meanwhile, patients always thought of their care as “integrated,” and likely didn’t fully understand the distinction between professional and technical services. Nevertheless, we collectively have messaged within the industry something like this: “You take care of your business and I will take care of mine.”

The economic reality of where we are today, with our total healthcare spend being in excess of $2 trillion, cannot – and should not support – that kind of inefficiency and misalignment. We need the collective insight that both, really all, parties bring to the table. It is my belief that those hospitals and healthcare systems that “crack the code” when it comes to solving the physician relationship and engagement issue will be advantaged in the marketplace, regardless of local market forces and dynamics. The models for such alignment are numerous and certainly not confined to full employment and all should be fully explored.

Issue 2 – Healthcare Leadership

Second, and very much tied to the issue above, is the whole topic around leadership in healthcare. No, we don’t just need to train up an army of physicians with graduate business degrees to take over and fix what needs to be fixed. Rather, we need to thoughtfully and respectfully look at how leadership in healthcare has evolved and how narrowly focused we’ve been – something I think has happened from natural progress and isn’t anyone’s fault.

Regardless, our thinking about what healthcare is, where does it start and stop, who are the crucial stakeholders, where are the boundaries, and not least the question of role clarity are critical. We need to be intentional about leadership re-design, and we need to be bold. We need to build upon the strengths of the current leadership model, but not be constrained by it.

Much is said in today’s environment about taking risk, and most of the time we are talking about financial risk associated with the healthcare premium dollar. But we also need to think about bold risk-taking around leadership, empowering leaders to boldly redesign a model that is better suited and adaptable to where we are going, and not where we have come from. What are the skills and competencies that we need to anchor around? What perceived, but outdated, strengths do we need to jettison? Simply put, where do we need to build muscle, and how do we get the new muscle to work with the old.

This kind of change won’t just happen on its own, but needs to be led by a few brave organizations that will take it head-on. I believe that those organizations will be advantaged in the marketplace. In considering this challenge, organizations should think about the following three things:

  1. Are our leaders currently equipped with the necessary skills and competencies to navigate the changing environment?
  2. Is our leadership and shared governance model the right one for us?
  3. Who do we need to engage to help us get from where we are to where we need to be?

Issue 3 – The Role of Boards

And one final thought: who is going to be the primary catalyst for change even if the only change we focused on were the two issues above? I for one believe that it is those who govern. One thing that has NOT changed in the current whitewater of healthcare is who has the final accountability for the long-term welfare of the organizations that make up the bedrock of our American healthcare system – our boards.

Given their connection to local communities, as well as their fiduciary responsibility to do what is best for those same communities, who else is better positioned to drive the challenging, and sometimes uncomfortable changes, that must take place? No longer can boards simply rely on what they learn from management regarding the current reality. They’re going to have to move into a posture that perhaps might be a little uncomfortable for all parties and begin to truly embrace a shared governance model. This shared model will more frequently challenges the status quo and isn’t reluctant to take the organizations that they serve to places that might seem a little daunting at first. A board might ask, “How much must we own, manage or control in order to have the kind of influence that we want to have on healthcare in this (our) market?” Make no mistake, boards will have a key and critical role in how the system of tomorrow is shaped.

As you see, the list is woefully incomplete, but we have to start somewhere. Many believe that the traditional players in healthcare cannot transform an industry as large and entrenched as is ours. I respectfully disagree and believe that real transformation from episodic acute care to true population health and comprehensive well-being can and should most effectively be led by those same people.

So as for me ….

  • Transformational physician engagement partnered with a …
  • Transformational leadership paradigm that is insisted upon by …
  • Transformational boards of governance willing to push the envelope

Not a bad place to start and we’re happy to help out!

This article will also be published on the Navvis Healthways blog and appears with permission of the author.

As senior vice president for Navvis Healthways, Dr. Anderson provides strategic counsel, planning and implementation support for physician integration and alignment, accountable clinical management, and strategic planning for the organization. Before joining Navvis Healthways, Dr. Anderson served as a senior vice president and chief medical officer for Baylor Health Care System in Dallas from 1995 until 2004, and held the same position at Catholic Health Initiatives (CHI) in Denver from 2004 until 2008. Dr. Anderson’s clinical background is that of a general and vascular surgeon. He holds an M.D. from the Baylor College of Medicine and a B.S. from Baylor University.

Topics: Healthcare Medical Costs & Utilization